A study of 6,000 electronic specialty consultations for person-centered care at The Mayo Clinic

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Published: Sep 11, 2012
DOI: https://doi.org/10.5750/ijpcm.v2i3.266
Keywords:
Delivery of health care electronic consults health care innovation person-centered medicine referral and consultation remote consultation specialty care

Main Article Content

Gerald D. Malagrino
Senior Project Manager, Center for Innovation, Mayo Clinic, Rochester, MN, USA
Rajeev Chaudhry
Assistant Professor of Medicine, College of Medicine and Consultant - Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
Matthew Gardner
Service Designer II, Center for Innovation, Mayo Clinic, Rochester, MN, USA
Michael Kahn
Business Liaison, Office of Access Management, Mayo Clinic, Rochester, MN, USA
Lloyd Speer
Coordinator, Clinical Operations, Mayo Clinic, Rochester, MN, USA
Barbara R. Spurrier
Associate Administrator - Innovation, Center for Innovation, Mayo Clinic, Rochester, MN, USA
Nicholas F. LaRusso
Director, Center for Innovation, Mayo Clinic, Rochester, MN, USA

Abstract

Rationale, aims, and objective: To study the utility and outcome of electronic specialty consultations between primary care physicians and specialists at a large, multispecialty academic practice and to determine best practices for this model.Method: Use of a common electronic health platform for the provision of ordering specialty care.  A new model was put in place in which an electronic consultation with a specialist could substitute for a face-to-face consultation for certain defined conditions.  The financial model for this type of consultation was set up at the Mayo Clinic.  All electronic consultations from January 2009 to September 2011 at the Mayo Clinic Rochester were evaluated for appropriate condition ordered, clarity of question, time to completion and time saved for the specialty practices.Results: Thirty-nine specialties participated in this new model of care to define 158 conditions; 6,253 electronic consults were performed with a greater than 98% quality rate for appropriate condition ordered and clarity of question, with 93% completed within 2 business days.  These consultations, termed eConsults, were accomplished in roughly one-half to one-third of the time of a face-to-face consultation, saving time for the specialist.Conclusions: The electronic consult is a new modality for a primary care physician to solicit specialists' input. While this model is not appropriate for every circumstance, it can provide significant value beyond that of a traditional face-to-face consultation.

Article Details

Issue
Vol. 2 No. 3 (2012): September
Section
Clinical and Electronic Communication

References

Adamson, S.C. & Bachman, J.W. (2010). Pilot study of providing online care in a primary care setting. Mayo Clinic Proceedings 85 (8) 704-710.

Chaudhry, R., Spurrier, B., Wood, D., LaRusso, N. Physician perspectives on electronic consultations: An opportunity for innovative specialty care. International Journal of Person Centered Medicine 2 (3) xxx-xxx.

Donohoe, M.T., Kravitz,R.L., Wheeler, D.B., Chandra, R., Chen, A. & Humphries, N. (1999). Reasons for Outpatient Referrals from Generalists to Specialists. Journal of General Internal Medicine 14 (5) 281–286.

Harno, K. (2004).“UUMA. Regional eHealth Services in the Hospital District of Helsinki and Uusimaa (HUS). Studies in Health Technology and Informatics 100, 101–108.

Patterson, V., Humphreys, J. & Chua, R. (2004). Email Triage of New Neurological Outpatient Referrals from General Practice. Journal of Neurology, Neurosurgery and Psychiatry 75 (4) 617–620.

Rushakoff, R.J. & Woeber, K.A. (2003). Evaluation of a ‘Formal’ Endocrinology Curbside Consultation Service: Advice by Means of Internet, Fax, and Telephone. Endocrine Practice 9 (2) 124–127.

Horner, K., Wagner, E. & Tufono, J. (2011). Electronic Consultations Between Primary and Specialty Care Clinicians: Early Insights. The Commonwealth Fund Issue Brief October 2011.

Bergus, G.R., Emerson, M., Reed, D.A. & Attaluri, A. (2006). Email Teleconsultations: Well Formulated Clinical Referrals Reduce the Need for Clinic Consultation. Journal of Telemedicine and Telecare 12 (1) 33–38.

Reichman, M. (2007). Optimizing Referrals and Consults with a Standardized Process. Family Practice Management 14 (10) 38–42.

O’Malley, A.S & Reschovsky, J.D. (2011). Referral and Consultation Communication Between Primary Care and Specialist Physicians: Finding Common Ground. Archives of Internal Medicine 171 (1) 56–65.

2010 Commonwealth Fund International Health Policy Survey.

Mehrotra, A., Forrest, C.B. & Lin, C.Y. (2011). Dropping the Baton: Specialty Referrals in the United States. Milbank Quarterly 89 (1) 39–68.

Bodenheimer, T. (2008). Coordinating Care—A Perilous Journey Through the Health Care System. New England Journal of Medicine 358 (10) 1064–1071.

O’Malley, A.S., Tynan, A., Cohen, G.R., et al. (2009). Coordination of Care by Primary Care Practices: Strategies, Lessons, and Implications, HSC Research Brief #12. Washington, DC: Center for Studying Health System Change. http://hschange.org/CONTENT/1058/.